Project Lead: Kirstie Coxon
Aims
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To explore, from the perspectives of women and their partners, the process of making decisions about place of birth when a range of options consistent with the Maternity Matters ‘choice guarantee’ is offered.
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To explore perceptions of risk and uncertainty that are held by women and their partners in relation to different places of birth (obstetric unit, alongside midwife-led unit, freestanding midwife-led unit, or home).
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To provide evidence about the extent to which perceptions of risk are shared, disputed and negotiated amongst women, their partners, their health professionals and wider social networks.
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To contribute new theoretical knowledge about how mothers and their partners make decisions about, or choose, an intended place of delivery, including consideration of the weight and influence of social, cultural and demographic contexts upon these decisions.
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To contribute empirically derived socio-cultural knowledge about the experiences and perceptions of men (and other birth partners) in relation to birth place decisions in the UK.
Why is this important?
Government policy proposes that by 2010, women with straightforward pregnancies should be offered the choice of having their babies in a range of settings, including consultant-led obstetric units, midwife-led units or at home (Department of Health 2007). Currently, there is little evidence about how women and their partners might decide where to give birth. The aim of this study is to provide a detailed and rigourous account of how women and their partners make decisions about intended place of birth during pregnancy, and how their subsequent experience of birth further shapes the views and beliefs that they hold.
This research will explore the experience of being asked to choose where to give birth from the perspectives of women and their partners. For generations, women in England have been encouraged to give birth in hospital, and have only recently been advised that it may be beneficial to give birth at home or in a midwife-led birth centre. For this reason alone, it may be difficult for some to feel that they are in a position to decide where they should give birth, even if they are offered a choice.
The policy of providing choice also creates challenges for service provision. Some women may opt to deliver at home when their health professionals advise against this, and others may opt to deliver in hospital, although they are considered at low risk of complications, thereby placing the provision of non-medical services for labour care at risk of becoming unsustainable. This study seeks to disentangle the many influences that are brought to bear on women and their partners, and to understand both the process and experience of ‘birth place’ decisions, so that key beliefs associated with place of birth are better understood. Individual concepts of safety and risk in relation to birth will also be identified, and the interplay between these and the choices that women and their partners make will be explored. In terms of safety and service quality, the study aims to provide a basis for facilitating birth in the most appropriate setting and to enhance the quality of communication amongst women, their partners and health professionals during pregnancy and birth.
Participants
During the course of the study, interviews with women and their partners will be conducted both in early pregnancy, and following birth. This prospective, longitudinal design will mean that intended place of birth can be considered, along with actual place of birth. The study is recruiting in three different NHS trusts which together provide a range of services that reflect the ‘Maternity Matters’ policy choice guarantee, two of which are in London and one in Kent.
The study seeks to recruit a diverse sample of women and partners from these settings, and to reflect the range of perspectives that women and their partners hold in relation to place of birth.
Anticipated outcomes
The purpose of this research is two-fold. Firstly, it addresses a question of policy implementation, by seeking to understand how the ‘Maternity Matters’ choice guarantee is perceived by women and their partners, and the extent to which risk assessments made on behalf of individuals are contested or accepted by them. To this end, the study will provide evidence about the influence of socio-cultural factors (such as parity, social class, proximity to services, cultural values and perceptions of risk and safety) that may influence women and their partners’ decisions about intended place of birth. The study will particularly address questions about why ‘low risk’ women with ‘normal’ pregnancies opt to give birth in a medical, consultant-led environment, as well as considering why women with complex or ‘high risk’ pregnancies might wish to give birth in lower risk settings.
Secondly, the study will contribute towards the theoretical social science literature through analysing the extent to which individuals feel able to make ‘birth place decisions’ in a socio-cultural context that is mediated by dominant ‘safety’ narratives around birth, and through exploring the role and influence of partners in contemporary ‘birth place’ decision making.